Assessment for an arterial component
Pulse
- +/- groin pulse?
- +/- food pulse?
Lack of pulse
- Skin inspection (Color, temperature, hair and nail growth, ulcer location, muscle atrophy).
- Delay in capillary refill time (>2 seconds).
- Reactive hyper-anaemia/paleness by elevation.
Puls palpation; Pitfalls
- Oedema
- Obestity
- Skin temperature < 27°C
- 5 to 10% have an alternative anatomic position of the pedal arteries
- Your own pulse can be interpreted as the pt.
- Small muscle movements in the foot can imitate a pulse
Ankle Brachial Index (ABI); Pitfalls
- Our blood pressure are dynamic and in constant change
- The patient have untreated hypertension
- Skin temperature < 27°C
- The rest time before measurement are < 5-10 minutes
- 5 to 10% – Alternative anatomic position of the pedal arteries
- Restlessness
How to interpret the Ankle-brachial index. Modified with permission from Aboyans V. et al., Editor’s Choice – 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg. 2018;55(3):313. (82)
Toe Pressure index (TBI) complement ABI
- ABI may be falsly normal or elevated owing to vessel stiffness (media calcification)
- Vessel stiffness are caused by diabetes, chronic kidney disease, or advanced age
- Toe vessels are less susceptible to medial calcification
Association between wound healing and pressure on toe and ankle level
International Consensus on the Diabetic Foot, 1999 Lepäntalo et al., J. Vasc. Endovasc. Surg, 2011,42;60-74
- The pulse is palpable down to 60-70mmHg
- Chance of wound healing is below 10% if the toe pressure is ≤ 30mmHg
Assessment for venous insufficiens on the lower leg
EWMA Document: Lower Leg Ulcer Diagnosis and Principles of Treatment
- All patients with a VLU should be considered for venous intervention in addition to compression therapy to improve ulcer healing and prevent recurrence.
- To identify venous insufficiency, an ultrasound examination is needed to assess the return flow of the blood from the lower leg back to the heart.
- Doppler ultrasound (DUS) (probe 5-17 MHZ) assessing the morphology and the hemodynamics of the flow in lower limb veins.
